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DOCUMENTS Initial Application Date: 'I S 'I Application# 1 aZ F a 1 CU# COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E.Front Sheet,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamett.org/permits "A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)6 SITE PLAN ARE REQUIRED MIENSUBMITTINGA LAND USE APPLICATION^ R LANDOWNER. L7-fn INA'A Le al Est Mailing Address: - n k3 `AN<1+ Grbvre. Ca. City: li I \��. lxin stateeSM Zip:3)5'I 4 Contact No'. -It�tS����➢ 1 Email: cm t 10 t di rYQ 0,01 . LB.', l APPLICANT': Lfr. y' f(''�'i Cs cf Mailing Address: l City: State: Zip: Contact No: Email: 'Please fill out applicant intormafion if different than landowner CONTACT NAME APPLYING IN OFFICE: Phone# PROPERTY LOCATION:��AvSubdivision. € ( � /'�<.1 Lot#. Lot Size:1 lcy'ea& a. State Road# \aL .Z State Road Name: r('a•a1'€✓^ �(� �,l�^sA Map Book 8 Pagge'.OZoM / 1 ` Parcel: b b 5a9 I5 th) t�9 PIN: V�`-7 W 3 - Zoning Flood Zone: '3/41� Watershed:Li\ Deed Book B Page:(0/91 q Power Company: 'New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: Monolithic ❑ SED'(Size x )#Bedrooms: #Baths:_Basement(w/wo bath):_Garage:_Deck: Crawl Space: Slab: Slab:_ (Is the bonus room finished?( )yes ( )no w/a closet?( )yes ( )no(if yes add in with#bedrooms) ❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame Off Frame_ (Is the second floor finished?( )yes (_)no Any other site built additions?(_)yes ( )no ❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms_Garage:_(site built?_)Deck: (site built? ) ❑ Duplex:(Size_x_)No.Buildings: No.Bedrooms Per Unit: ❑ Home Occupation:it Rooms: Use: 9 ��Hours �of Operation: '. #Employees Addition/Accessory/Other:(Size NS 3 0)Use: DO\ \ OeJ re—Cm- GQ Closets in addition?(_)yes ( )no Water Supply: 'County Existing Well New Well(#of dwellings using well )*Must have operable water before final Sewage Supply: New Septic Tank(Complete Checklist) ✓ Existing Septic Tank(Complete Checklist) County Sewer Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?(_)yes (j.)no Does the property contain any easements whether underground or overhead( )yes (k)no Structures(existing or proposed):Single family dwellings: ✓ Manufactured Homes: Other(specify): Required Residential Property Line Setbacks: Comments: r c30 k r1 OJ c-Q 1 \,.4j Q Front Minimum 3n5( Actual lu0 COY/ ,,`tm t.t� loci tic x\llard. �T� Rear 81 a V{.l`FA_ �� r� � Is.�-C./_Q�`.A�^ ^qYN Closest Side C D t Cr‘ `tji -—f lea.. s. '10l� Sidestreet/corner lot C7fj,Q �-�[ Nearest Building rAHsI 1TVLL on same lot Residential Land Use Application Page 1 of 2 03/11 APPLICATION CONTINUES ON BACK W.1 eyfir SPEC ICDIRECTIONS�T`O THE PROPERTY FROM LILLINGTON:` 21 (. *0 ` r N f 14- UroiArn \\d '�( 14. S n, I-3 © Ls-v, lfN[3f tri V� a3 ♦ •\ cy (01 tT' rOIZrnchb , yAA R� tv —C. CL,rn\n.. a)F- r6... (ZZ ty A an, 2, \%%- If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted. I hereby state that foregoing statements are accurate and correct to the of my knowledge. Permit subject torevocation if false information is provided. Signature of Ow r or Owner' t Date 'It is the owner/applicants responsibility to provide the Bounty with any applicable information about the subject property,including but not limited to:boundary information,house location,underground or overhead easements,etc.The county or its empfbyees are not responsible for any Incorrect or missing information that Is contained within these applications." • "This application expires 6 months from the initial date if permits have not been issued" • Residential Land Use Application Page 2 of 2 03/11 1 1 3 a t i ii 11, 1 SITE PLAN APPROVAL 1 DIStRICTV1'" USE?, CIL1 wyCOe kBEDROOMS C IS nate zU rotor trA 0QN / y r r n tlS k r i ia CO 49o s ! "4fi IJ .' li Liyu y pp I I° i s J it SITE PLAN APPROVAL DIS -ICI \^Yl ..) US- kBEDRka S . 11 i rz 1a- Il_ e - e 4 I Will i 1 NAME: APPLICATION#: *This application to be tilled out when applying for a septic system inspection.* County Health Department Application for Improvement Permit and/or Authorization to Construct IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED,OR THE SITE IS ALTERED,THEN THE IMPROVEMENT PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration depending upon documentation submitted. (Complete site plan=60 months;Complete plat=without expiration) 910-893-7525 option I CONFIRMATION# Environmental Health New Septic SystemCode 800 • All property irons must be made visible. Place 'pink property flags" on each corner iron of lot. All properly lines must be clearly flagged approximately every 50 feet between corners. • Place "orange house corner flags"at each corner of the proposed structure. Also flag driveways, garages,decks, out buildings, swimming pools,etc. Place flags per site plan developed at/for Central Permitting. • Place orange Environmental Health card in location that is easily viewed from road to assist in locating property. • If property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property. • All lots to be addressed within 10 business days after confirmation.$25.00 return trip fee may be incurred for failure to uncover outlet lid,mark house corners and property lines. etc. once lot confirmed ready. • After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code 800 (after selecting notification permit it multiple permits exist) for Environmental Health inspection. Please note confirmation number given at end of recording for proof of request. • Use Click2Gov or IVR to verify results. Once approved,proceed to Central Permitting for permits. Environmental Health Existing Tank Inspections Code 800 • Follow above instructions for placing flags and card on property. • Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if possible)and then put ltd back In place. (Unless inspection is for a septic tank in a mobile home park) • DO NOT LEAVE UDS OFF OF SEPTIC TANK • After uncovering outlet end call the voice permitting system at 910-893-7525 option 1 &select notification permit if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number given at end of recording for oroof of request. • Use Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits. SEPTIC If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one. I Accepted {_} Innovative (_} Conventional { j Any ( ) Alternative {_} Other The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION: {_}YES (_) NO Does the site contain any Jurisdictional Wetlands? {_}YES {_}NO Do you plan to have anion system now or in the future? {_IVES { I NO Does or will the building contain any drains'?Please explain. I_IyE$ ( I NO Arc there any existing wells,springs.waterlines or Wastewater Systems on this property? (_)YES ( } NO Is any wastewater going to be generated on the site other than domestic sewage? {_(YES (_) NO Is the site subject to approval by any other Public Agency? {_(YES {_J NO Are there any Easements or Right of Ways on this property? (_)YES {_}NO Does the site contain any existing water,cable,phone or underground electric lines? If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service_ I Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules. I Understand That I Am Soldy Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making The Site Accessible� � So That A Complete Site Evaluation Can Be Performed. PROPERRTIOWNE•� Rt.�. LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) LIID TE 10/10 09109111 Application# Harnett County Central Permitting PO Box 85 NC 27518 Each section below to be Mbd out 910 893 7525 Fax 010 89393 2793 2793 www hamett erprpermds by whomever performing wort Must be owner or licenced contractor Address company Apoltcalton for Residential Building and Trades Permit name&phone must match Owners Name Date Site Address Phone Directions to job site from Lillington Subdivision Lot Description of Proposed Work #of Bedrooms Heated SF Unheated SF Finished Bonus Room/_Crawl Space _Slab SC ) trGeneral Contractor Information . e‘•.11 4-Cue, r'rtie) qIv Sib ?)la Building Contractors Company Name Telephone Address Email Address License# gleaned!Contractor Information Descnption of Work Service Size _Amps T-Pole _Yes_No St 1k Crv.. uZ1 'LC, rs Ft-e t) ilio 5{`10 l -cat Electrical Contractors Company Name Telephone Address Email Address License# Mechanical/HVAC Contractor Information Description of Work Mechanical Contractor s Company Name Telephone Address Email Address License# Plumbing Contractor Information Description of Work #Baths Plumbing Contractors Company Name Telephone Address Email Address License# insulation Contractor Information Insulation Contractors Company Name&Address Telephone *NOTE General Contractor must fill out and sign the second pegs of this application I hereby certify that I have the authority to make necessary application that the application is correct and that-the construction will conform to the regulations in the Building Electrical Plumbing and Mechanical codes and the Harnett County Zoning Ordinance I state the information on the above contractors is correct as known to me and that qv sranrna below I have obtained all subcontractors permission to obtain these permits and if Ni!changes occur including listed contractors site plan number of bedrooms building and trade plans Environmental Health permit changes or proposed use changes I certify it is my responsibility to notify the Harnett County Central Permitting Department of any and all changes EXPIRED PERMIT FEES-5 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee is as per current fee schedule (-//J s I / s Signature of Owner/Cor tractor/Officer(s) rporauon Date Affidavit for Worker's Compensation N C G S 87-14 The undersigned applicant being the General Contractor _Owner Officer/Agent of the Contractor or Owner Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporabon(s)performing the work set forth in the permit Has three(3)or more employees and has obtained workers compensation insurance to cover them Has one(1)or more subcontractors(s)and has obtained workers compensation insurance to cover them Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance covering themselves /Has no more than two(2)employees and no subcontractors While working on the project for which this permit is sought it is understood that the Central Permitting Department issuing the permit may require certificates of coverage of workers compensation insurance prior to issuance of the permit and at any time during the permitted work from any person firm or corporation carrying out the work Company or Name Sign wmde 'fii� Date (1 d 5 Il HARNETT COUNTY CASH RECEIPTS *0* CUSTOMER RECEIPT *4* Oper: JBROCK Type: CP Drawer: 1 Date: 4/26/18 52 Receipt no: 332738 Year Number Amount 2018 50043881 1713 ERNEST BROWN RD LILLINGTON, NC 27546 B4 BP - ENV HEALTH FEES f10B.B0 EXT TANK MELODY ESTEP Tender detail CK CHECK PAYMEN 3494 $108.00 Total tendered $100.00 Total payment Trans date: 4/26/18 Time: 14:08:34 as THANK YOU FOR YOUR PAYMENT ma